Stroke education - success and limitations
There is increasing evidence that success of acute stroke treatment is strongly influenced by the timepoint of intervention (“time is brain”). Therefore, intensive and costly educational campaigns are undertaken aiming to reduce the time delay between symptom onset and hospital presentation. Earlier studies have suggested that such efforts are impressively successful. However, most studies have major limitations because they were either center-based or excluded many patients from analysis because of various reasons. Objective: To study prospectively the impact of an educational campaign on acute stroke patients in a community-based approach. Methods: All consecutive patients who were admitted to all 16 Cologne hospitals (1 Mio. inhabitants) with the diagnosis of presumed stroke were documented within a first 3-month period before and a second 3-month period after an intense state-of-the-art campaign of 1 year duration. Results: 1281 patients were documented, 618 met the final diagnosis of ischemic stroke. In 495 patients the time interval between symptom onset and hospital arrival could be obtained. In these patients, the median time interval only marginally decreased from 340 to 320 min. If only those patients were taken into consideration (as in most earlier studies) who were admitted within 24 hours of symptom onset and whose time of stroke onset could accurately be assigned (only 286 patients) the result would look much more impressive: median time interval decreased from 130 to 90 min. Conclusion: The potential effect of educational campaigns to encourage early hospital arrival in acute stroke patients should not be overestimated. Only in a small subgroup of stroke patients a substantial success could be demonstrated.